Pediatrics

patient 1.25 year 9.3 kg weight came with c/o watery stool and vomiting and fever patient was manage on opd basis in morning with zinc and pre pro biotics and antibiotic and anti emetic patient came again and admitted in eveng with c/o watery stools and fever ..high grade cbc 6300 hb6.9 plt 3 lac crp negative sodium 144 K... 4.1 cl..103 widal negative managed with ivf and amikacin given 15 mg /kg pcm iv also given 2nd day... watery stools 10-15 times every 15-20mins metrogyl 30mg/kg started enterogemina given pcm fever still high grade investigation tlc 2600 crp positive plt 2.3 lac hb 6.8 how to manage the case

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Acute gastro enteritis ,? Viral . Since CRP is positive, likely to be bacterial .But since there is leukopenia, consider viral . Continue IV fluids to replace fluid loss . IV ceftriaxone , metrnidazole , oral probiotic . Vitals should be watched . Hypotension, acute kidney injury to be watched. Stool culture, especially for Claustridium deficil , hanging drop examination for vibrio cholera should be done . Blood culture for typhoid, Anemia should be investigated . Small repeated blood transfusions should be given to urgently bring the Hb to 9 grams.
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L&s free milk also started if there's history of bottle feeding.if present also see for megaloblastic anaemia.go with stool exam& culture. Manage with iv fluids, antibiotics upgrade to pipercillin+tazo, metrogyl, antipyretic, antiemetic, l&s free milk
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Why amikacin was started immediately . Its nephrotoxic . Child was already dehydrated . Its infective diarrhea . As crp has become positive . Widal test should only b done after 1 week of fever . In first week blood c/s n IgM typhidot remain investigation of choice . Maintain hydration with iv fluids . Give ceftriaxone at a dose of 75 mg/kg/day. I would recommend whole blood transfusion for quick recovery . Send comment on peripheral blood smear . Need to r/o malaria too. U can add syp ralop . Continue rest . Use econorm instead of enterogermina.
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Few things which are missing, I feel... is the duration of symtoms, past history , Rota vaccine status, hydration status, PBS and MCV not mentioned with this hb level With rest of the details, it seems like an infective diarrhoea.... a blood culture, stool r/e, c/s and urea, creat ,PBS, retic should be considered (to r/o prerenal azotemia) Rest conservative rx, IVF and empirical xone will suffice for the time being
Thank you doctor
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Case of infective diarrhoea Antibiotics I’m fluids should be given according to deficit I v fluids till vomiting after recovery iron tonic to correct anemia
Sir tlc 2600 antibiotics to b given?
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IV fluid Zinc. Enterogermina. AD10 sachet. Inj Cefotaxime. Metrogyl Stop. Blood for CBC, culture. Stool culture. Urine RE ME. CXR PA view.
gastroenteritis please give Vilwadi tab with honey and 1/4 teaspoon jinger juice .and vilwadi lehyam chewing.

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